Prolonged Eye Contact

Unsafe abortion poses serious threat to Rwandan women’s* health

The first national estimates of abortion incidence in Rwanda show that one in 40 women aged 15–44 had an abortion in 2009 and that virtually all of these abortions were clandestine procedures that are highly likely to be unsafe. The study, conducted by the National University of Rwanda’s School of Public Health and the U.S.-based Guttmacher Institute, in collaboration with the Ministry of Health, found that an estimated 60,000 induced abortions occurred that year, which translates to a national rate of 25 abortions per 1,000 women of reproductive age. This is lower than the abortion rate for Sub-Saharan Africa as a whole (31 per 1,000) and for Eastern Africa (36 per 1,000).

The researchers, who gathered data from a nationally representative sample of health facilities and knowledgeable key informants, found that 25,000 women—more than 40% of women who had an abortion—suffered complications that required medical treatment. However, 30% of these women did not receive the medical care they required, indicating a greater need for postabortion care than is currently being provided.

A substantial proportion of abortion complications are likely due to the actions of untrained providers, such as traditional healers, lay practitioners, pharmacists, or pregnant women themselves. Such procedures may involve ingesting dangerous substances or inserting sharp objects into the body to end a pregnancy.

[…]

Approximately 20% of Rwandan women will require treatment for complications from an unsafe abortion at some point in their lifetime. The study found that the quality of postabortion care was poor throughout the health system. While 92% of health facilities in the country provide some form of treatment for abortion complications, the majority do not use techniques recommended by the World Health Organization.

Though the number of women who die from unsafe abortions in Rwanda is not known, the World Health Organization estimates unsafe abortion accounts for 17% of all maternal deaths in Eastern Africa.

The researchers also found that despite growing modern contraceptive use in Rwanda, 47% of all pregnancies in the country are unintended.

[…]

“Abortion Incidence and Postabortion Care in Rwanda” , by Paulin Basinga, et al. appears in the March 2012 issue of the journal Studies in Family Planning.

Pre-abortion ultrasound: the medical evidence and why it’s important [Dr. Jen Gunter]

The growing momentum among state legislators to enact ultrasound “requirements” for abortion is an interesting tactic. Currently 20 states regulate the provision of ultrasound by abortion providers. The point appears to be twofold:

• raise the cost of the procedure to reduce the number of women who can afford an abortion
• require/offer/describe a view of the fetus to dissuade/shame pregnant women into not having the procedure

It’s interesting to me that on both sides there has been very little discussion of the medical evidence. So that’s what I’m going to do.

Issue #1: Cost

Second-trimester abortion

Let’s just take that off the table. Every second trimester abortion needs an ultrasound and often gets more than one. Second-trimester abortions are more often done for birth defects, typically diagnosed or confirmed by ultrasound (sometimes a few ultrasounds are done). In addition, these procedures require more skill the further along, so it is essential the practitioner knows the gestational age with as much accuracy as possible. Ultrasound laws will not change any procedure costs for 2nd trimester ultrasounds, but they may affect the viewing requirements (whether the woman sees/hears a description of the ultrasound). I’ll get to that in just a bit.

First-trimester abortion

Many providers already do a 1rst trimester ultrasound, especially with medical abortion. This is because a medical abortion can only be done up to 63 days (9 weeks). However, there is a growing body of literature suggesting medical abortion can safety be accomplished without an ultrasound for 98% of women. So these laws will prevent practitioners from doing away with an ultrasound (i.e. prevent them from practicing evidence based medicine) which will halt efforts to expand medical abortion into low resource settings. Ultrasound requirements will also affect many women getting a surgical procedure as and ultrasound is typically not required if the size of the uterus agrees with the dating of the pregnancy (although some providers do ultrasounds anyway, generally for medico-legal reasons).

So regarding cost, ultrasound requirements may affect a lot of women seeking a 1rst trimester abortion.

Does this accomplish anything? (Which you might want to know if you are going to spend tax payer money enacting a law). No. In fact, studies tell us that both cost and local availability of a provider has no effect on the decision to get an abortion, it simply delays the procedure while the woman figures out her resources. It is insulting to insinuate that a woman has an abortion out of convenience or cost. In Canada, where abortion is free and unencumbered by ill-informed politicians, the rate of abortion is lower than in the United States. It is sex education and widespread access to medical care and contraception that reduces abortion, not laws.

Issue #2: Viewing the image to dissuade a woman from having an abortion

A 2009 study looked at whether viewing an ultrasound image pre-abortion was something women wanted and whether it had an impact on her choice to have the procedure or her emotional experience(1). When given the option, almost 73% of women chose to view their ultrasound image and of those who did, 85% felt it was a positive experience. Not one woman changed her mind about having the abortion after viewing the image. Ten women were selected for an in-depth interview on the subject and all felt that women should be given the choice about viewing their image.

So in fact, states that require a provider to offer a view of the image to the patient are following evidence-based recommendations. Requiring a patient view the image, such as in Texas, is another matter.

We know that cost and laws do not affect the abortion rate. We also know that long acting reversible contraception lowers the abortion rate. There are some excellent studies that tell us that when women get depo-provera or an IUD post-abortion they are far less likely to have a subsequent unplanned pregnancy. But interestingly, many in the anti-choice movement also discourage birth control. If they were really pro-life (i.e. wanting to prevent every abortion possible) they would be handing out contraceptives instead of picketing clinics and clamoring for laws that restrict tobacco, as cigarettes are responsible for the deaths of 5-7% of all premature babies and cause 23-31% of SIDS).

Laws that increase barriers to abortion create hardships for the women seeking the procedure but they do nothing to lower the abortion rate. To focus on abortion restrictions and not contraception is the height of hypocrisy and a waste of taxpayer dollars, because the laws will inevitably get challenged and held up in court, as we have seen in South Carolina and Oklahoma.

Sigh. (See my recent piece, What if all the money spent fighting about abortion…).

There is no medical evidence to support ultrasound laws. They are a waste of taxpayer dollars and do nothing to accomplish the goal of reducing abortion. They also create a dangerous precedent of allowing hypocritical politicians to set unacceptably low standards of medical care based on political goals, religion, and misogyny.

Smaller government indeed.

1) Kulier R, Kapp N. Comprehensive analysis of the use of pre-procedure ultrasound for first- and second-trimester abortion. Contraception 2011; 83:30-33.

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*Pregnant people, not just cis women.

Here’s a link to an abstract for the study mentioned above.

Let’s add this to the studies and articles I’ve already mentioned on this blog:

• Women’s Perceptions About Seeing the Ultrasound Picture Before an Abortion
• Women’s Experience of Viewing the Products of Conception After an Abortion
• Abortion Debate: Little Evidence Sonograms Change Minds, Doctors Say
• Study: Ultrasounds Do Not Influence Women’s Decisions On Abortion
• Ultrasounds don’t change minds, people often find them reassuring for their decision to abort
• Ultrasounds don’t stop planned abortions

Report: Plan B Access Limited in Native Communities

Compared to the rest of the United States, the rates of sexual violence among Native American women are nearly twice as high; one in three Native women will be raped in her lifetime, according to the Native American Women’s Health Education Resource Center. But in many Native communities, women have little to no access to emergency contraception, the group reports in a new paper advocating for greater access.

On many reservations, the only medical facilities are the Indian Health Service centers, which are a federally administered division of the Department of Health and Human Services. The Native American Women’s Health Education Resource Center’s research found that only 10 percent of the pharmacies in the IHS offered Plan B, or “the morning after pill”—the leading form of emergency contraception—over the counter. Forty percent only provide Plan B with a prescription, and the other half don’t provide the pill at all. The federal government approved over-the-counter sales for women over the age of 18 in 2006, and for 17-year-olds in 2009, but access has lagged in the IHS.

Reservation communities are often rural and geographically isolated, and lack any private pharmacies that carry EC, said Charon Asetoyer, chief executive officer of the Native American Women’s Health Education Resource Center in the introduction to the report. Often, the IHS service centers are closed on the weekends, and the women must wait hours or even days to see a doctor in order to obtain a prescription. This can mean the woman misses the 72-hour window during which EC is effective in preventing pregnancy. The alternative requires driving long distances to a nearby city, which can pile additional costs on top of a pill that already costs $50.

The report includes accounts of women from all over the country detailing their own experiences with the IHS health centers. They also spoke to pharmacists, who noted that there are many reasons that they don’t carry EC: the committees that decide what to stock have neglected to put the drug on approved lists; medical staff have decided that Plan B isn’t necessary; decision-makers think the drug is too expensive; doctors haven’t requested the drug. The IHS did not respond to a request for comment on the report before press time. Women in these communities should not be held to the religious, cultural, or personal beliefs of decision-makers, the report argues.

Asetoyer argues this not carrying and providing EC violates the sexual assault protocols recommended by the Department of Justice for women seeking medical attention following a rape, which include pregnancy risk evaluation and prevention measures. It also violates the Tribal Law and Order Act of 2010, said Asetoyer, which was put in place to ensure that federal laws are enforced on reservations, and the rights to self-determination protected by the United Nations Declaration on the Rights of Indigenous People.

Access to emergency contraception prevents Native women from having to deal with additional trauma of needing an abortion should she have a pregnancy resulting from rape, said Asetoyer. “Who wouldn’t want to help a woman reduce that trauma?”

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*All people who can get pregnant, not just cis women.

This is shameful. I wish I could say this surprises me, but it doesn’t in the least. This is just one more example of how race, class, gender, and geographic location intersect to suppress reproductive rights. And it’s truly a tragedy because Plan B is safe, easy to use, and would be so beneficial for reducing unwanted pregnancies, yet it is being kept out of vulnerable people’s hands because of politics and bureaucracy. It just goes to show that we can’t claim victory when we maintain the legality of things like Plan B or abortion, victory will only happen when everyone has access to them.

New Research Blames Low-Income African American Women for Couples' Contraceptive Choices

An excerpt (I recommend reading the whole thing):

Recently, I was asked by a reporter to comment on a study titled, “Cash, Cars and Condoms: Economic Factors in Disadvantaged Adolescent Women’s Condom Use.” The purpose of the study was to “evaluate whether adolescent women who received economic benefits from their boyfriends were more likely never to use condoms.” My first question was, “Why is this question even being asked?”  As I read the study, my questions grew—as did my dismay at reading this examination of girls’ condom use that asked no questions of the men whose penises would actually be covered by these condoms.

…

The researchers, who used data collected from African-American girls and women ages 15 to 21 living in a low-income area (we’ll come back to that in a sec), did indeed conclude that “adolescent women whose boyfriend is their primary source of spending money may not explicitly exchange risky sex for money, but their relationships may be implicitly transactional.”

Well, duh.

Is this conclusion truly publication-worthy? Of COURSE their relationships are transactional—every single relationship is transactional.  And it doesn’t matter what one’s socioeconomic status or racial or ethnic background is; it doesn’t matter what the gender(s) of the partners in the relationship are. We all negotiate wants, needs, and desires with our partners. We make choices based on what we have and do not have.  We communicate well, we communicate poorly—and we make decisions with which some will agree and others will disagree.

The difference here, however, is that what was being examined was whether the male partners of these young women provided them with money. And right there you have a not-so-veiled statement: low-income, African-American girls are whores. Think I’m exaggerating? Just read the key words beneath the article’s abstract, which include “sexual behavior; safe sex; adolescent” and “prostitution.” 

What if we took a look at a middle-income, white couple in their early thirties? One partner or spouse works outside of the home, and the other stays at home and raises their 2.5 children. This is a transactional relationship. In a male-female relationship, we will most likely see the male partner playing the breadwinner role and the female partner staying home—although this has been shifting more over the years with more stay-at-home dads. The choice of who will work and who will stay home is a transaction between the partners. It is one that involves and reflects, among other things, each partner’s capacity to earn money. Yet no one would look at the stay-at-home mom in this example who accepts money from her partner to run their home as being “paid” by her spouse, and certainly no one would imply that any stay-at-home mom is a prostitute.

What the results of this study communicate is, “if these poor, African-American adolescents didn’t rely on their boyfriends for money, maybe they’d make better decisions about their sexual health.” This is a useless conclusion in relationships that involve far more complex issues than whether a boyfriend has money or a car. It is an equally useless measurement of safer sex practices, because girls and women do not use latex condoms, their male partners do.  But this is far from the only study that examines girls’ use of one of the only male contraceptive and safer sex methods (“Women’s Condom Use Drops During First Year in College” is slated to be published in the next Journal of Sex Research). Each study that does this renews the misplaced blame on girls and women for not being stronger in insisting that their male partners use condoms—instead of helping us reaffirm that both partners in a relationship have equal responsibility in determining how best to avoid an STD and/or pregnancy.

…

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This study is cis-centric (as is the critique) but it’s important information to keep in mind when evaluating studies like this and the racial/class undertones that are often present in how the data is interpreted by researchers as well as why they choose their specific research questions in the first place.

SEX EDUCATION LINKED TO DELAY IN FIRST SEX

Excerpt from Guttmacher press release:

Teens who receive formal sex education prior to their first sexual experience demonstrate a range of healthier behaviors at first intercourse than those who receive no sex education at all. This is particularly so when the instruction they receive includes information about both waiting to have sex and methods of birth control. These findings come from a new study, “Consequences of Sex Education on Teen and Young Adult Sexual Behaviors and Outcomes,” by Laura Duberstein Lindberg and Isaac Maddow-Zimet of the Guttmacher Institute.

The authors analyzed data from 4,691 men and women aged 15–24 who participated in the 2006–2008 National Survey of Family Growth. They found that 66% of sexually experienced females and 55% of sexually experienced males reported having received information about both abstinence and birth control prior to first intercourse. Eighteen percent of sexually experienced females and 21% of males had received only abstinence instruction, while 16% of females and 24% of males had had no instruction on either topic. However, these measures do not correlate directly with any specific “abstinence-only” or “comprehensive” sex education programs (see below).

Respondents who had received instruction on both abstinence and birth control were older at first sex than their peers who had received no formal instruction and were more likely to have used condoms or other contraceptives at first sex; they also had healthier partnerships. Those who had received only abstinence instruction were more likely to have delayed first intercourse than were those who had had no sex education, but abstinence instruction was not associated with any of the other protective behaviors at first sex. Moreover, condom use at first sex was significantly less likely among females who had had only abstinence instruction than among those who had received information about both abstinence and birth control. The study found no relationship between sex education and current sexual behaviors, suggesting the need for ongoing education after the onset of sexual activity.

…

“Consequences of Sex Education on Teen and Young Adult Sexual Behaviors and Outcomes,” by Laura Duberstein Lindberg and Isaac Maddow-Zimet, is currently available online and will appear in a forthcoming issue of the Journal of Adolescent Health.

For a comprehensive review of research findings on the effectiveness of comprehensive and abstinence-only sex education programs, click here.

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I’m looking at you Utah.

Would be interesting to know if there are any studies on sexual debut or sexual behavior which aren’t focused on cis and binary demographics. If you know of any, I’d love to read them!

NH, you're doing it wrong: State Representative claims birth control causes prostate cancer

racetothestoneage:

CONCORD, NH - New Hampshire’s Representative Jeanine Notter (R-Merrimack) told committee members today that health plans shouldn’t cover birth control because it causes prostate cancer.

Rep. Notter sits on the State-Federal Relations and Veterans Affairs Committee, which heard public testimony today on late-entry House Resolution 29, urging the United States Department of Health and Human Services to rescind its rule requiring health plans to cover preventative services for women such as contraceptives.

According to the Mayo Clinic, prostate cancer is cancer that occurs in a man’s prostate.

This isn’t the first time Rep. Notter’s notions have generated public attention; last February she told cancer patients that they didn’t need the new health law because they could host community fundraisers to cover health care costs instead.

Rep. Notter can be reached at (603) 423-0408 or by email, jeanine.notter@leg.state.nh.us.

Click through to watch the video.

+3 to New Hampshire for Rep. Notter’s embarrassing ignorance.

The audio of this is horrendous but I’m pretty sure she’s parroting the conservative pundits who leapt on a study last year about how places where there is higher oral contraceptive use also have higher rates of prostate cancer. Now any reasonable person would say correlation doesn’t equal causation, which is exactly what the researchers note in their study. It didn’t stop conservatives from making outrageous claims though, and now it seems these conclusions have made it all the way to the NH legislators who obviously aren’t qualified to evaluate a scientific study.

And for those wondering: no one is saying people with prostates are taking the pills nor is she relaying the idea incorrectly, the suggestion is that the pill hormones are excreted in the user’s urine and then contaminate the water and might feminize fish, adversely affect “men’s” fertility and so on.

It should also be noted that not just cis men have prostates.

(Source: seriouslyamerica)

Researchers debunk study linking abortions to mental health issues

safe-legal-abortion-is-prolife:

“Researchers from the University of California, San Francisco (UCSF) and The Guttmacher Institute debunked a 2009 study in the Journal of Psychiatric Research linking abortions to mental health issues.

In a press release Monday morning, the editor of the journal agreed with the new analysis that found fundamental analytical errors in the study. UCSF’s Julia Steinberg and Guttmacher’s Lawrence Finer sent the editor a letter in the March 2012 edition of the journal, chastising the original study’s top figure, Priscilla Coleman, and her colleagues’ work for fundamental analytical errors.

“This is not a scholarly difference of opinion, their facts were flatly wrong,” Steinberg said. “This was an abuse of the scientific process to reach conclusions that are not supported by the data. The shifting explanations and misleading statements that they offered over the past two years served to mask their serious methodological errors.”

The press release also slammed Coleman’s work, citing that she chose to draw conclusions despite not distinguishing “between mental health outcomes that occurred before abortions and those that occurred afterward.”

Anti-abortion activists have cited Coleman’s research as helping in their propaganda, with the faulty information also spread by federally and state-funded crisis pregnancy centers.”

shocking…

(via ladyatheist)

GOP Rep. On Birth Control: ‘We’re Not Talking About Scientists, I’m Asking About Religious Belief!’

The Senate voted to table an amendment that would permit an employer to deny contraception coverage to their employees on Thursday morning, but the debate over birth control raged into the afternoon, as HHS Secretary Kathleen Sebelius testified before the House Energy and Commerce Committee.

Just moments after Senators defeated the so-called Blunt Amendment, Rep. Tim Murphy (R-PA) accused Sebelius of lying about the administration’s rule requiring employers to provide birth control coverage in their health insurance plans and falsely insisted that religious organizations would be required to provide “abortifacient” drugs:

SEBELIUS: There also is no abortifacient drug that is part of the FDA approved contraception. What the rule for preventive care…

MURPHY: Ma’m that is not true…Is the morning after pill or something like that an abortifacient drug?

SEBELIUS: It is a contraceptive drug, not an abortifacient… It does not interfere with a pregnancy. If the morning pill were taken, and a female were pregnant, the pregnancy is not interrupted. That’s the definition of abortifation.

MURPHY: Ma’m that is your interpretation, and I appreciate that’s your interpretation.

SEBELIUS: That’s what the scientists and doctors…

MURPHY: We’re not talking about scientists. Ma’m we’re not talking about scientists here, we’re talking about religious belief. Ma’m, I’m asking you about a religious belief. In a religious belief, that is a violation of a religious belief.

When Sebelius went on to explain that the administration’s contraception rule “upholds religious liberty” by exempting houses of worship, religious nonprofits that primarily serve people of the same faith, and even religiously-affiliated hospitals and colleges from providing birth control, Murphy exclaimed, “Ma’m, ma’m, NO! NO! You’re Wrong!” “You’re setting up a rule that not even Jesus and his apostles could adhere too.” Watch it:

Regardless of what God may have told Murphy about the morning after pill, the administration’s guidance does not include drugs that can induce abortions. As the rule explains that insurers and employers must cover “Evidence-based items or services that have in effect a rating of A or B in the current recommendations of the United States Preventive Services Task Force (Task Force)” and “the comprehensive guidelines supported by the Health Resources and Services Administration.” The contraception language is included in the HRSA guidelines, it reads: “All Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity.” Those include:

Male Condom, Female Condom, Diaphragm with Spermicide, Sponge with Spermicide, Cervical Cap with Spermicide, Spermicide Alone, Oral Contraceptives (a.k.a. “the pill”), Patch, Vaginal Contraceptive Ring, Shot/Injection, Emergency Contraceptives, IUD, Implantable Rod, Vasectomy, Transcervical Surgical Sterilization Implant for women

These methods act to “prevent pregnancy before, and only before, fertilization occurs.” Emergency Contraceptives like Plan B — which Murphy attempted to paint as an “abortion pill”– halts the union of sperm and oocyte and inhibits ovulation. It does not work after fertilization.

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See, that’s the pesky thing when we’re dealing with facts. There is no, “let’s just agree to disagree” nonsense. There’s facts and then there’s bullshit, and Republicans have decided to vehemently endorse and embrace bullshit. I don’t need to consult the bible (or any other holy text) to find out if Plan B is an abortifacient, I just need to consult the medical and scientific community that has overwhelming shown that it’s not an abortifacient. Not when we use the accepted medical definition of pregnancy (implantation) and not when we use the antichoice definition of pregnancy (fertilization). I don’t care what your “beliefs” are. We can’t make laws or decisions based on subjective, untestable beliefs. We need facts, and the facts have always been on our side. Cue the inevitable whining but the facts are black and white on this issue, Murphy. Keep your “interpretation” to yourself.

U.S. TEEN PREGNANCY RATE AT LOWEST LEVEL IN NEARLY 40 YEARS

Teen pregnancies have declined dramatically in the United States since their peak in the early 1990s, as have the births and abortions that result; in 2008, teen pregnancies reached their lowest level in nearly 40 years, according to “U.S. Teenage Pregnancies, Births and Abortions, 2008: National Trends by Age, Race and Ethnicity,” by Kathryn Kost and Stanley Henshaw of the Guttmacher Institute. In 2008, the teen pregnancy rate was 67.8 pregnancies per 1,000 women aged 15–19, which means that about 7% of U.S. teens became pregnant that year. This rate represents a 42% decline from the peak in 1990 (116.9 per 1,000). Similarly, the birthrate declined 35% between 1991 and 2008, from 61.8 to 40.2 births per 1,000 teens; the abortion rate declined 59% from its 1988 peak of 43.5 abortions per 1,000 teens to its 2008 level of 17.8 per 1,000.

Even with dramatic reductions in pregnancy, birth and abortion rates among all racial and ethnic groups, disparities between black, white and Hispanic teens persist. After peaking in the early 1990s, the teen pregnancy rate dropped by 37% among Hispanics, 48% among blacks and 50% among non-Hispanic whites; yet the rates among black and Hispanic teens remain 2–3 times as high as that of non-Hispanic white teens. There were also considerable disparities in birth and abortion rates. The birthrates in 2008 among black and Hispanic teens, as well as Hispanic teens’ abortion rate, were twice the rates among whites; the abortion rate for black teens was four times that of whites.

“The recent declines in teen pregnancy rates are great news.” says lead author Kathryn Kost. “However, the continued inequities among racial and ethnic minorities are cause for concern. It is time to redouble our efforts to ensure that all teens have access to the information and contraceptive services they need to prevent unwanted pregnancies.”

A large body of research has shown that the long-term decline in teen pregnancy, birth and abortion rates was driven primarily by improved use of contraception among teens. And while there was also a decrease during the 1990s in the overall proportion of females aged 15–19 who were sexually experienced, there has been almost no change in the proportion in recent years. Continuing decreases in teen pregnancy more recently may be driven by increased use of the most effective contraceptive methods as well as dual method use. In sum, teens appear to be making the decision to be more effective contraceptive users, and their actions are paying off in lower pregnancy, birth and abortion rates.

[Emphasis mine]